Outpatient surgery managers are ordering more surgical masks, asking staff and patients about recent travel to areas with swine flu outbreaks, and reinforcing hand hygiene in preparation for a potential swine flu pandemic.

"We have ordered masks with no problem," reports Peggy Alteri, RN, BSN, MPS, CASC, administrator and CEO of Holdings, which owns and operates two freestanding surgery centers in Syracuse, NY, and president of the MMAE consulting firm, which specializes in ambulatory surgery development and accreditation. The 200 masks are for staff who interview patients, says Alteri, who also is president of the New York State Association of Ambulatory Surgery Centers.

"These masks will be worn by staff in 'high-risk' situations," says Alteri, who also is president of New York State Association of ASCs. High-risk situations include patients who have traveled to areas of swine flu pandemics and are symptomatic, or are simply symptomatic but haven't traveled to those areas, she says. "The intent is that we would screen the patients who are high risk at the time of pre-testing and before their surgery."

The Centers for Disease Control and Prevention (CDC) has rolled out pandemic-level infection control guidelines for health care facilities treating patients with the swine flu strain. As of May 6, the CDC had confirmed 642 cases in 41 states. From an initial epicenter in Mexico City, the swine flu also has been detected in 22 countries. A pandemic had not been officially declared by the Word Health Organization (WHO), but the situation is changing rapidly. Though cases were still being confirmed in Mexico at press time, health officials there estimate that the death count is 29 out of some 822 cases. At press time, there has been two fatalities reported in the United States. The CDC has taken the initial steps to begin seeding and producing vaccine. Federal officials have said it likely will be months before a vaccine can be produced.

When the federal government declared an official "public health emergency," officials shipped millions of doses of antiviral drugs to states reporting cases of swine flu and other states. At press time, the Food and Drug Administration was working with the CDC to distribute diagnostic tests to local and state public health labs.

Richard E. Besser, MD, acting director of the CDC, suggested that businesses should make contingency plans for workers who might call in sick. At a media briefing, he said, "Hopefully, this outbreak would not progress, but leaning forward and thinking about what you would do is one of the most important things individuals and communities can undertake right now."

Two of the probable swine flu cases are at the University of Chicago Medical Center, where both employees were reported to be at home and recovering well. The two had no patient contact and limited staff contact, the hospital reported. The hospital is screening employees, members of the university community, and patient with flu symptoms, it reported. Additionally, the hospital has posted employees at its entrances to monitor patients for flu symptoms, and anyone entering the hospital is being asked to use hand sanitizer.

Alteri sent a memo to her staff that said if they had traveled to Mexico or New York City, they are at high risk for swine flu and should report that travel to the administrator. She also pointed out that there was a suspected case in Cortland, NY. She instructed staff to ask all pre-testing and surgical patients if they had recently traveled to Mexico, California, New York City, or are from the Cortland, NY, area. "This question is to be asked of EVERY patient, and whether they have traveled to these areas or not needs to be documented," Alteri said in her memo. "If a patient has traveled to one of these areas, or is symptomatic, please advise an anesthesiologist, and an assessment of the patient will be done."

She instructed staff that if they are symptomatic and are experiencing any two of the following symptoms, they should not report to work, and they should seek immediate medical attention: fever, cough, sore throat, body aches, headache, and chills. "Please provide me with a document from your physician that you have been screened for swine flu," Alteri told staff. Additionally, she attached a list of frequently asked questions from the New York State Department of Health. [A copy of Alteri's memo and the FAQs are included with the online issue.]

At FWI Healthcare, an Edgerton, OH-based consulting firm primarily for ambulatory health care providers, employees were discouraged from visiting Mexico over spring break due to dangers associated with the drug cartels and other factors, says Roger Pence, president. That advice ended up paying off in terms of limiting staff members' exposure to the swine flu, he reports.

Managers at FWI Healthcare's centers have reinforced their practices regarding hand washing and coughing/sneezing, monitored employee's health conditions, and checked each patient's health status as appropriate, he says. When patients show flulike symptoms, depending on the severity, staff ask the surgeons, anesthesiologists, or medical directors to evaluate the patients' physical condition and determine if they are healthy enough for surgery.

In terms of staff, "our centers have a personnel policy that permits the administrator to have them assessed, by a physician, send them home, or relieve them of direct patient care, if they are suspected of being infectious," Pence says.

If your location is hard hit by the swine flu, consider offering masks to employees as a "good will bonus" to keep them healthy and as a psychological benefit, he advises. "In fact, if the center has an adequate supply, why not offer them to patients and family members, or even the general public?" Pence says. "It might be a real marketing ploy."

Resources

For more information on preparation for the swine flu and pandemics, see:

The Association for Professionals in Infection Control and Epidemiology (APIC) has infection preventionists available for consulting. This information is available at www.apicconsulting.com. APIC Consulting Services Inc.'s (ACSI's) consultants have experience in all aspects of infection prevention and control, including emerging pathogens and emergency preparedness. ACSI's clients include all types of health care facilities.

Recommendations issued for suspected swine flu

CDC issues guidelines for bronchoscopy

The Centers for Disease Control and Prevention (CDC) has issued the following guidelines to prevention nosocomial transmission of an emerging swine influenza virus:

Any patients who are confirmed, probable, or suspected cases and present for care at a healthcare facility should be placed directly into individual rooms with the door kept closed. Healthcare personnel interacting with the patients should follow the infection control guidance in this document. For the purposes of this guidance, healthcare personnel are defined as persons, including employees, students, contractors, attending clinicians, and volunteers, whose activities involve contact with patients in a healthcare or laboratory setting.

Procedures that are likely to generate aerosols (e.g., bronchoscopy, elective intubation, suctioning, administering nebulized medications), should be done in a location with negative-pressure air handling whenever feasible. An airborne infection isolation room (AIIR) with negative pressure air handling with 6 to 12 air changes per hour can be used. Air can be exhausted directly outside or be recirculated after filtration by a high-efficiency particulate air (HEPA) filter. Facilities should monitor and document the proper negative-pressure function of AIIRs, including those in operating rooms, intensive care units, emergency departments, and procedure rooms.

Procedures for transport of patients in isolation precautions should be followed. Facilities should also ensure that plans are in place to communicate information about suspected cases that are transferred to other departments in the facility (e.g., radiology, laboratory) and other facilities. The ill person should wear a surgical mask to contain secretions when outside of the patient room, and should be encouraged to perform hand hygiene frequently and follow respiratory hygiene/cough etiquette practices [available at www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm].